\u03b2-blockers and risk of all-cause mortality in patients with chronic heart failure and atrial fibrillation\u2014a meta-analysis

Tianyu Xu,Yunzhao Hu,Dingli Xu,Yujia Bai,Yuhui Zhang,Haobin Zhou,Yuli Huang,Jian Zhang,Xingfu Huang

doi:10.1186/s12872-019-1079-2

Abstract

BackgroundEffects of β-blockers on outcomes in patients with chronic heart failure (CHF) and atrial fibrillation (AF) is still in controversy.MethodsSearching was conducted by using keywords “atrial fibrillation”, and “heart failure” in PubMed, MEDLINE and Embase databases before November 30, 2017. Prospective studies [i.e. randomized control trials (RCTs), post-hoc analysis of RCTs, prospective cohort studies and registry studies] that studied the effect of β-blockers and all-cause mortality in patients with CHF and AF were included. The analysis was stratified by study design.ResultsWe identified 12 studies, including 6 post-hoc analysis of RCTs and 6 observational studies (including prospective registry studies and prospective cohort studies), which enrolled 38,133 patients with CHF and AF. Overall, β-blockers treatment was associated with significant decrease in all-cause mortality [Risk Ratio (RR) =0.73; 95% Confidence Interval (CI) 0.65–0.82, P < 0.001]. When stratified by study design, β-blockers treatment was associated with 34% reduction in patients with CHF and AF in observational study (RR = 0.66; 95% CI 0.58–0.76, P < 0. 001), but not in post-hoc analysis of RCT (RR = 0.87; 95% CI 0.74–1.02, P = 0.09).Conclusionsβ-blockers treatment was associated with significantly decrease the risk of all-cause mortality in patients with AF-CHF and it was only seen in observational study group, but not in subgroup analysis of RCT group. Further large RCTs are required to verify the effect of β-blockers treatment on patients with CHF and AF. The main limitation of this study is the lack of individual data on patients in each study.

Highlights

Effects of β-blockers on outcomes in patients with chronic heart failure (CHF) and atrial fibrillation (AF) is still in controversy
A meta-analysis with four randomized control trials (RCTs) indicated that β-blockers did not decrease the risk of all-cause mortality and Heart failure (HF) hospitalization in CHF patients with AF [10]
Abstracts and full text, we excluded 46 articles due to duplicates, 2, 741 articles on account of irrelevance, 5 articles because of patients in which were not diagnosed with AF and CHF, 8 articles for no controlled group, 12 articles for no all-cause mortality data, 2 articles for from the same study, and 12 studies, including 38, 133 patients were included for analysis in this study [15, 16, 22,23,24,25,26,27,28,29,30,31] (Fig. 1)

Summary

Introduction

Effects of β-blockers on outcomes in patients with chronic heart failure (CHF) and atrial fibrillation (AF) is still in controversy. Large amounts of studies confirmed that it could decrease the rate of mortality and hospital readmission for HF of HFrEF in sinus rhythm (SR) [8,9,10] and β-blockers had been recommended as Class IA in guidelines in treating those CHF with SR patients by both U.S.A. and Europe [4, 11]. A meta-analysis with four RCTs indicated that β-blockers did not decrease the risk of all-cause mortality and HF hospitalization in CHF patients with AF [10]. The European Society of Cardiology-Heart Failure (ESC-HF) Registry demonstrated that β-blockers could reduce the all-cause mortality in CHF and AF patients [Hazard ratio: 0.52; 95% Confidence Interval (CI) 0.31–0.89; p = 0.02], especially in the group with patients’ HR between 80 and 109 b.p.m. Findings from one cohort study support the idea that β-blockers could show a reduction of all-cause mortality in AF and CHF groups (Hazard ratio: 0.63, 95% CI: 0.50–0.79) [16]

Methods

Results

Conclusion